CPC Exam Podiatry 2025 with
correct questions and detailed
answers 2025 verified
hospital employee who converts documented
procedurs and diangoses into medical codes -
✔✔ANSWER ✔✔-Abstractor
coding practices that lead to improper
reimbursement by error because they do not meet
medical necessity, ex. changing diagnosis to be
covered by insurance - ✔✔ANSWER ✔✔-Abuse
,an examination process the healthcare facility goes
through to evaluate the facilities policies,
procedures, and performance to meet higher
standards. - ✔✔ANSWER ✔✔-Accreditation
Having seal of approval after being evaluated and
demonstrating quality standards - ✔✔ANSWER ✔✔-
Accredited
Legislation passed through Congress and signed by
President or passed over his veto - ✔✔ANSWER ✔✔-
Act/ Law/ Statute
The amount the provider charges for medical
services or supplies. Not always paid in full. -
✔✔ANSWER ✔✔-Actual Charge
Health care services not covered by Medicare and
are offered through the Medicare Advantage
,Organization for no additional premium. The
benefits must equal the ACR (Adjusted Community
Rating) - ✔✔ANSWER ✔✔-Additional Benefits
Health Insurance Claims process at the insurance
company - ✔✔ANSWER ✔✔-Adjudication
Estimate of how much Medicare will spend in a year
for an average beneficiary - ✔✔ANSWER ✔✔-
Adjusted Average Per Capita Cost (AAPCC)
Non medical code sets that characterize a general
business situation rather than a medical condition. -
✔✔ANSWER ✔✔-Administrative Code Sets
Medicare, Medicaid, CMS refer to this as their
expenses to have the program, operating expenses,
program management, etc. - ✔✔ANSWER ✔✔-
Administrative Costs
, Health insurance information stored in automated
information system about enrollment, eligibility,
claims, etc. - ✔✔ANSWER ✔✔-Administrative Data
hearing officer who presides over appeal conflicts
between providers or beneficiaries, and Medicare
contractors (MAC's) - ✔✔ANSWER ✔✔-
Administrative Law Judge (ALJ)
Part of HIPAA authorizing HHS (Health and Human
Services) to 1. adopt standards for transactions &
code sets; 2. adopt standard identifiers for health
plans; 3. adopt standards to protect security &
privacy of personally identifiable health information.
- ✔✔ANSWER ✔✔-Administrative Simplification
Signed 12/17/01 allows HHS (Health & Human
Services) to exclude providers from Medicare for
HIPAA non-compliance of electronic claims and
correct questions and detailed
answers 2025 verified
hospital employee who converts documented
procedurs and diangoses into medical codes -
✔✔ANSWER ✔✔-Abstractor
coding practices that lead to improper
reimbursement by error because they do not meet
medical necessity, ex. changing diagnosis to be
covered by insurance - ✔✔ANSWER ✔✔-Abuse
,an examination process the healthcare facility goes
through to evaluate the facilities policies,
procedures, and performance to meet higher
standards. - ✔✔ANSWER ✔✔-Accreditation
Having seal of approval after being evaluated and
demonstrating quality standards - ✔✔ANSWER ✔✔-
Accredited
Legislation passed through Congress and signed by
President or passed over his veto - ✔✔ANSWER ✔✔-
Act/ Law/ Statute
The amount the provider charges for medical
services or supplies. Not always paid in full. -
✔✔ANSWER ✔✔-Actual Charge
Health care services not covered by Medicare and
are offered through the Medicare Advantage
,Organization for no additional premium. The
benefits must equal the ACR (Adjusted Community
Rating) - ✔✔ANSWER ✔✔-Additional Benefits
Health Insurance Claims process at the insurance
company - ✔✔ANSWER ✔✔-Adjudication
Estimate of how much Medicare will spend in a year
for an average beneficiary - ✔✔ANSWER ✔✔-
Adjusted Average Per Capita Cost (AAPCC)
Non medical code sets that characterize a general
business situation rather than a medical condition. -
✔✔ANSWER ✔✔-Administrative Code Sets
Medicare, Medicaid, CMS refer to this as their
expenses to have the program, operating expenses,
program management, etc. - ✔✔ANSWER ✔✔-
Administrative Costs
, Health insurance information stored in automated
information system about enrollment, eligibility,
claims, etc. - ✔✔ANSWER ✔✔-Administrative Data
hearing officer who presides over appeal conflicts
between providers or beneficiaries, and Medicare
contractors (MAC's) - ✔✔ANSWER ✔✔-
Administrative Law Judge (ALJ)
Part of HIPAA authorizing HHS (Health and Human
Services) to 1. adopt standards for transactions &
code sets; 2. adopt standard identifiers for health
plans; 3. adopt standards to protect security &
privacy of personally identifiable health information.
- ✔✔ANSWER ✔✔-Administrative Simplification
Signed 12/17/01 allows HHS (Health & Human
Services) to exclude providers from Medicare for
HIPAA non-compliance of electronic claims and
